Cholera: Pains, sorrow

By Enyeribe Ejiogu, Cosmas Omegoh (Lagos), Gyang Bere (Jos), Chijioke Agwu (Abakaliki),  Olanrewaju Lawal (Birnin Kebbi), John Adams (Minna), Geoffrey Anyanwu (Enugu) and Sola Ojo (Kaduna)

Twenty years after governments at the federal, state and local government levels began to trumpet the ‘dividends of democracy,’ following the restoration of democratic rule in Nigeria, the majority of the citizenry in semi-urban and rural areas are still in abject lack of potable water.

Water, as anyone knows, is vital to the sustenance of life as it makes up 75-80 per cent of the body. All physiological and metabolic processes in the body occur in water in the cytoplasm of cells of the body.

Clean, potable water is, therefore, very important for good health. But the adequacy or even near total absence of potable water from deep boreholes or pipe-borne water has left people in communities to depend on less-than-healthy sources of water, which are more often than not contaminated with faecal matter that spread life threatening germs that cause outbreaks of water-borne diseases like cholera.

In Nigeria, as noted on the website of the Nigeria Centre for Disease Control (NCDC), cholera is an endemic and seasonal disease, occurring annually mostly during the rainy season and more often in areas with poor sanitation.

The first series of cholera outbreaks were reported between 1970 and 1990. Major epidemics also occurred in 1992, 1995-1996, and 1997. The Federal Ministry of Health reported 37,289 cases and 1,434 deaths between January and October 2010, while a total of 22,797 cases of cholera with 728 deaths and case-fatality rate of 3.2 per cent were recorded in 2011.

In 2018, 42,466 suspected cases were recorded, resulting in 830 deaths with a case fatality rate of 1.95 per cent from 20 out of 36 states from the beginning of 2018 to October 2018.

More recently, the NCDC reported that 289 Nigerians were killed by cholera in the outbreaks that occurred from January to June, 2021.

Similarly, there were 10,833 suspected cases reported during the same period, as the agency disclosed in a statement, adding that states such as Plateau, Kebbi, Enugu, Bauchi, Gombe, Kano, Zamfara, Bayelsa and Kaduna were affected by the outbreaks.

Plateau

In Plateau State, residents are now living in despair as dozens of them were hospitalized in different medical facilities in the state.

It was learnt that most of the victims contacted the disease as a result of poor hygiene practices at home and from consumption of fruits and vegetables that are not properly washed.

More importantly, non-availability of clean potable water was also attributed as a major reason for the outbreak of the disease.

A victim at the Plateau Specialist Hospital, Ladi James, told Sunday Sun that she was shocked by the manner the disease ravaged her.

Her words: “I found myself stooling and vomiting persistently before I was rushed to the hospital. I think I am lucky to have been brought to the hospital; if not certainly I wouldn’t have made it. I can’t explain what really happened to me, I don’t even know what I ate, but I thank God I am recuperating. Several persons died in their home because they couldn’t afford to come to the hospital.”

The Commissioner of Health in the state, Dr. Nimkong Lar, disclosed that the state had so far recorded 953 cases of cholera resulting in the deaths of 14 persons.

 He explained that 910 persons were hospitalized, treated and discharged while 29 patients were still receiving treatment in various health facilities across the state as at the time of filing this report.

The outbreak occurred in Jos North Local Government Area, and then spread to the neighbouring Jos South before spreading further to 13 out of the 17 local government areas of the state.

In addition to real-time medical intervention, Plateau State government has reintroduced monthly sanitation to ensure good hygienic environment in the state and prevent fresh outbreaks.

The government has also stepped up public awareness campaigns to educate the citizenry and urged them to avoid using water from ponds for domestic chores.

Ebonyi 

Also, Ebonyi State is one of the states in the country that still witnesses intermittent outbreaks of cholera.  Almost every year, the disease resurfaces in the state with tragic consequences.

In 2020, the disease killed many people in Ohaukwu , Izzi and Ebonyi local government areas of the state, but the government intervention led to the successful treatment of over 68 victims,  according to the then Commissioner for Information, Daniel Umezuruike.

However, on July 6, last year, there was a fresh outbreak in Amachi-Igwebuike village, Agba, in Ishielu Local Government Area of the state.

Three persons were reportedly killed while 12 others were hospitalized at Agba General Hospital for treatment as Sunday Sun learnt from the acting Commissioner for Health in the state, Dr. Richard Nnabo, who briefed journalists, noting that the state is on the recovery trajectory from the outbreak.

He attributed the three deaths recorded to the refusal of the patients to go to the hospital for treatment.

Nnabo disclosed that the state government had commenced robust sensitization and enlightenment campaign in the area and other communities on how to prevent the disease.

“Every hospital in the state has been equipped to treat patients. We have also commenced sensitization and enlightenment campaign to sensitive Ebonyi people especially those in the rural areas on how to avoid the disease. People are advised to always keep their environments clean and hygienic, drinking safe water and to preserve their food items very well,” he said.

Nnabo implored the people to report any further cases of cholera to the nearest health facility or go straight to the General Hospital were drugs have been provided for the treatment.

But a member of Agba community, Mr Obasi Edeneh, blamed the outbreak of the disease on lack of good drinking water in the community.

He claimed that lack of good drinking water in many parts of the community made the people to resort to drinking pond water and water from other dirty sources.

“The truth is that this cholera comes with dirty water. We don’t have good water in the community. The ones there are not enough. Our people are still drinking pond water. I want to use this medium to appeal to the government to do something urgent to ensure provision of good drinking water for our people,” he said.

Kebbi

Unlike some other states, Kebbi State had few cases of cholera outbreaks in villages and towns in 2017, 2018, 2019 and this year.

The state government under the leadership of Governor Abubakar Atiku Bagudu was able to control the outbreaks through environmental sanitation and provision of potable water.

In 2018 in Hiroshi village in Kalgo Local Government Area, there was an outbreak that caused the death of a three-year-old girl who died while receiving treatment at the primary healthcare centre.

And in 2017, 18 people died from another outbreak in the Dole-Kaina area of Dandi Local Government Area of the state.

The victims were among the 216 victims that were on admission at a hospital in Dole-Kaina in Kamba area of Kebbi State, close to the border with Niger Republic.

Another 20 victims reportedly died in Tungar Buzu, Korama, Samanaji and Keri communities in Shanga, Birnin Kebbi, Fakai and Koko/Besse local government areas of the state.

During the outbreak, Governor Bagudu visited Yauri General Hospital and Rukubolo village to see cholera victims and promised to rehabilitate and upgrade the facilities in the hospital.

He expressed satisfaction with the prompt care given to victims, which resulted in their quick recovery and discharge.

To forestall future outbreaks, the state government has stepped the campaign against open defecation just as it has stepped up efforts to provide potable water to people in the various communities.

Moreover, the state governor has granted approval for the renovation of 35 primary healthcare centres across the state.

Commissioner for Health, Alhaji Jafar Muhammad who disclosed the cheery news explained that the initiative is part of measures to improve healthcare delivery in the state.

Niger

In Niger State, about 15 local government areas have experienced outbreaks resulting in 32 deaths. And in the past one month, 75 cases of cholera disease were recorded.

Expectedly, the development raised serious concerns. As Sunday Sun learnt from the Director of Public Health in the state, Dr. Idris Ibrahim, the majority of the victims died before they could reach the hospital.

The death toll would have been more if not for the quick intervention by the state government in deploying health officials to all the government areas in the state, Ibrahim said.

The effected local governments include, Suleja, Bosso, Tafa, Chanchaga, Paikoro, Gurara, Munya, Rafi, Shiroro, Agwara, Rijau, Kontagora, Magama, Mariga and Bida, with Shiroro recording the highest number of deaths due to inability of health officials to reach the people as a result of the activities of armed bandits.

The government made moves to curtail the spread of the disease through deployment of health personnel, provision of drugs, sustained enlightenment campaign among the people on how to avoid infection and handling of infected relations.

However, Sunday Sun gathered that the biggest challenge is the inability of the people to report suspected cases of cholera in their locality and the their penchant for resorting to self-medication without advice from healthcare professionals.

Enugu

Residents of the Enugu State on July 16 this year woke up to the discovery of strange deaths at the New Artisan Market, Enugu.

On that fateful day, seven dead bodies, including four men and three women were found in the market, with eight others in critical condition.

The affected persons, which included tricycle riders, artisans and others from different households, were said to be stooling and vomiting.

Officials of the Enugu State Ministry of Health quickly mobilized to the place to investigate the cause of the deaths and the next day the result was out and it was cholera.

State Commissioner for Health, Dr. Emmanuel Obi, who confirmed the outbreak of cholera in a state, said that only seven persons died.

He, however, said that 19 other persons were discovered to have been infected by the disease in the same market and were immediately taken to the ESUT Teaching Hospital for treatment.

Though the ministry and commissioner refused to give update on the outbreak and what is being done to forestall future occurrences, Obi has assured that the situation is under control to prevent further spread of the disease.

Kaduna 

Kaduna State has proved to be difficult in efforts to obtain updated data on cholera outbreaks despite efforts made at both the Ministry of Health and Infectious Disease Centre in the state.

However, the government through the Ministry of Health has taken steps to minimise the effect of any disease outbreak,  including cholera.

According to the Epidemiology Unit of the Health ministry, an outbreak of cholera occurred in 17 local government areas in the state and the government initiated emergency response involving secondary health facilities in each of the LGAs for management of the cases.

The unit equally claimed to have distributed drugs for the hospital management, distributed chlorine for purification of water and carried out sensitization on preventive measures in communities which is ongoing.

The unit further said that it had done contact tracing of all affected people and intensified efforts on the ongoing active case search in communities and other health facilities.

On awareness creation, the unit said that it is supporting ongoing radio jingles on prevention of cholera while surveillance is also ongoing in order to identify more cases.

Failure of governance cause of persistent outbreaks

“In every way, the primary reason for the frequent outbreaks of cholera infection in communities across Nigeria is the failure of governance,” a consultant in Public Health at a tertiary health facility in the Southeast, who pleaded anonymity,  said.

The source said: “It is regrettable that 61 years after Nigeria gained independence, this country that is a major producer and exporter of crude oil, a country swimming in money, a country where a legislator could splash out N100 million to buy a customised luxury car, a nation where state governors cruise in armour-plated vehicles and engage in wanton acts of profligacy cannot provide something as commonplace as potable water for the citizenry, it’s a situation that should make them bury their heads in the sand of shame. Do you know that Dubai extracts billions and billions of clean drinking water from sea water?

“I recall that between 2008 and 2010, then Imo State Governor Ikedi Ohakim made giant efforts to build solar powered boreholes in over 300 communities in the state. If solar-powered boreholes are spread like seeds in rural communities, that will go a long way to ending the ravaging effects of the frequent outbreaks of cholera which is essentially a water-borne disease.

“It is just saddening that we lack good leaders. Most of the health problems in the country are caused by failure of governance. If you remove the factor of lack of potable water and educate the people on proper toilet practices the incidence of cholera outbreaks will be reduced to the minimum. Ultimately, good governance, manifested in true provision of the dividends of democracy as the governments and politicians always love to make noise about, will be the real solution to end the scourge of cholera outbreaks.”

Chief Medical Director, Anglican Hospital, Ibadan, Dr Gbenga Alo, explained that cholera infection is essentially transmitted through the feaco-oral route whereby V. cholera pathogens passed out through the feaces of an infected person somehow get into the mouth of another person, either by drinking water contaminated with the faecal matter or eating contaminated fruits or vegetables not properly washed with clean water.

“Once the micro-organism involved finds its way into the infected person’s feaces into the mouth of somebody, that person is bound to suffer from cholera. So, it is basically a disease of poor hygiene,” he said, adding that “water source is the commonest way to contract cholera.”

He, therefore, advised that “people should try and improve on their personal hygiene and simply avoid drinking just any type of water. Everyone should ensure that the water they drink is well treated either by boiling or chemically treating their water to kill micro-organisms in it.

“Moreover, there is clear and present need for state governments and their mass communication organs to ratchet up public awareness campaign against open defecation. People should build toilets in their homes, even if it is covered pit toilet. The practice of people defecating in open drains or flowing water must be actively discouraged because the micro-organism that causes cholera can easily contaminate fruits and vegetables when use to irrigate nearby farms.”